A healthy 33-year-old woman with no cardiac risk factors feels thumps or skipped beats in her chest a few times a day regardless of activity. An event recorder showed premature ventricular contractions (PVCs) (no couplets or triplets) that correlated with symptoms. The woman reports no light-headedness, chest pain, racing heart, or shortness of breath. Is any other workup warranted?
—Leigh Bears, ARNP, New London, N.H.
PVCs are common and typically benign. However, a 12-lead ECG and electrolyte panel should be completed. In particular, hypokalemia and hypomagnesemia can cause PVCs. The patient should track the events for any triggers. Common triggers include tobacco use, caffeine, alcohol, illegal drugs, anxiety, hypertension, exercise, asthma medications, tricyclic antidepressants, and OTC decongestants. PVCs can also be caused by injury to the heart (e.g., coronary artery disease, congenital heart disease, hypoxia, and myocarditis). If you suspect heart disease, a transthoracic echocardiogram is warranted.
—Debra Kleinschmidt, PhD, PA (115-11)